Case Report of an Unusual Presentation of Brain Ischemia and Herniation in a Four Years Old Girl with COVID-19 Infection

Abstract

Introduction: COVID-19 is typically a mild or asymptomatic disease in children, but some children, with or without known underlying conditions, are at increased risk of severe disease and can experience severe illnesses such as MIS-C, cardiac, and neurological problems. Case Presentation: In this case report, we present one of these severe neurological conditions. A four-year-old girl was admitted to the hospital with a history of abdominal pain, respiratory tract infection, and fever persisting for 12 days before admission, not improved by outpatient treatments. At the time of admission, the child had bilateral pleural effusion. Chest tube placement and two liters of fluid drainage led to negative pressure pulmonary edema, resulting in intubation and mechanical ventilation, and echocardiography revealed a significant decrease in cardiac ejection fraction. After successful extubation, the child developed loss of consciousness, anisocoria, and decreased strength in the right limbs, while brain imaging showed infarct and edema. Due to brain herniation, the patient underwent craniotomy, and after the necessary treatments, she gradually recovered. Her nasopharyngeal COVID-19 PCR was positive, and she was diagnosed with MIS-C. Conclusions: Cases with COVID-19 infection can develop severe respiratory and neurologic problems. Prompt diagnosis and treatment can be lifesaving.